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Background To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge. Methods Ninety-seven people participated in this cross-sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the 'early heart rate increase'; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as 'early heart rate recovery.' An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability. Results A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low-frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group. Conclusions Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non-invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.

Background Electrocardiogram abnormalities have been reported during electroconvulsive therapy (ECT). A corrected QT interval (QTc) prolongation indicates delayed ventricular repolarization, which can trigger ventricular arrhythmias such as torsade de pointes (TdP). We examined the QTc changes during generalized tonic-clonic seizures induced by ECT, and the effects of atropine sulfate on these QTc changes. Methods We analyzed heart rate, QT interval, and QTc in 32 patients with depression who underwent ECT (25 women, 67.4 ± 8.7 years of age). The QTc from -30 to 0 seconds prestimulation was used as baseline, which was compared with QTc at 20-30 seconds and 140-150 seconds poststimulus onset. Results QTc was significantly prolonged at 20-30 seconds poststimulus, then significantly decreased at 140-150 seconds poststimulus, compared with baseline. QTc prolongation induced by ECT was significantly decreased by atropine sulfate. Conclusions These data suggest that the risk of TdP may be enhanced by ECT. Further, the risk of cardiac ventricular arrhythmias, including TdP, may be reduced by administration of atropine sulfate.

Fibromyalgia (FM) is a stress-associated syndrome with chronic, widespread pain. Patients with FM also present disturbances of cognition and memory. As the hippocampus is vulnerable to stress exposure and involved in cognition, memory and pain perception, we hypothesize that the abnormal function of the hippocampus is implicated in the pathophysiology of FM. N-acetylaspartate (NAA), a metabolite that can be measured using proton magnetic resonance spectroscopy (1H MRS), is recognized as a marker of neuronal structure and function. We performed a systematic review and meta-analysis of 1H MRS studies investigating NAA levels in patients with FM. A comprehensive literature search through MEDLINE, Embase and Web of Science yielded nine studies; among these nine, four studies met our criteria for inclusion. A random effect model with 51 patients with FM and 38 controls revealed a significant NAA reduction in the hippocampus. The current meta-analysis suggested a neuronal abnormality in the hippocampus in patients with FM.

Prevalence and symptoms of attention-deficit hyperactivity disorder (ADHD) change with advancing age. However, neurochemical background of such age-related change is yet to be elucidated. We therefore conducted a meta-analysis of 16 proton magnetic resonance spectroscopy studies comprising 270 individuals with ADHD and 235 controls. Standardized mean differences were calculated and used as an effect size. Sensitivity analyses and meta-regression to explore the effect of age on neurochemical abnormality were performed. A random effects model identified a significantly higher-than-normal N-acetylaspartate (NAA) in the medial prefrontal cortex (mPFC), but no significant differences of other metabolites in that area. No significant difference in metabolite levels was demonstrated in any other region. Sensitivity analysis of children with ADHD revealed significantly higher-than-normal NAA, whereas no significant difference was found in adults with ADHD. Meta-regression revealed significant correlation between advanced age and normal levels of NAA in the mPFC, suggesting that age-dependent abnormality of NAA level in the mPFC is a potential neural basis of age-related change of symptoms of ADHD.

OBJECTIVE The main purpose of this study was to translate the Calgary sleep apnea quality of life index (SAQLI) and to evaluate the reliability, validity and responsiveness of the Japanese version of the SAQLI (SAQLI-J). METHODS Translation of the SAQLI questionnaire into the SAQLI-J questionnaire was performed following the guidelines of cross-cultural adaptation of health-related quality of life (QOL) measures. All patients completed the following questionnaires both at baseline and three months later: the SAQLI-J, the medical outcome survey short form (SF-36) and the Epworth sleepiness scale (ESS). The SAQLI-J was conducted by an interviewer. PATIENTS One hundred and fifteen obstructive sleep apnea hypopnea syndrome (OSAHS) patients were recruited into the present study. RESULTS The internal consistency and test-retest reliability of the total SAQLI-J scores (SAQLI-J total) were both excellent. Regarding construct validity, the SAQLI-J was tested by measuring the inter-domain correlation between the SAQLI-J domains and the SF-36 domains. All of the SAQLI-J domains and the SAQLI-J total were found to be moderately to highly correlated with the domains of the SF-36. Moreover, the responsiveness of the SAQLI-J total measured according to the standardized response mean was found to be moderate, and the SAQLI-J was found to be more responsive than the SF-36 for detecting changes in the QOL after continuous positive airway pressure treatment. CONCLUSION The results suggest that the SAQLI-J is a valid, reliable and responsive health-related QOL questionnaire for use in Japanese OSAHS patients.

Objectives To assess the possibility that diffusion tensor imaging (DTI) can detect white matter damage in mild traumatic brain injury (mTBI) patients via systematic review and meta-analysis. Methods DTI studies that compared mTBI patients and controls were searched using MEDLINE, Web of Science, and EMBASE, (1980 through April 2012). Results A comprehensive literature search identified 28 DTI studies, of which 13 independent DTI studies of mTBI patients were eligible for the meta-analysis. Random effect model demonstrated significant fractional anisotropy (FA) reduction in the corpus callosum (CC) (p¼0.023, 95% CIs � 0.466 to � 0.035, 280 mTBIs and 244 controls) with no publication bias and minimum heterogeneity, and a significant increase in mean diffusivity (MD) (p¼0.015, 95% CIs 0.062 to 0.581, 154 mTBIs and 100 controls). Meta-analyses of the subregions of the CC demonstrated in the splenium FA was significantly reduced (p¼0.025, 95% CIs � 0.689 to � 0.046) and MD was significantly increased (p¼0.013, 95% CIs 0.113 to 0.950). FA was marginally reduced in the midbody (p¼0.099, 95% CIs � 0.404 to 0.034), and no significant change in FA (p¼0.421, 95% CIs � 0.537 to 0.224) and MD (p¼0.264, 95% CIs � 0.120 to 0.438) in the genu of the CC. Conclusions Our meta-analysis revealed the posterior part of the CC was more vulnerable to mTBI compared with the anterior part, and suggested the potential utility of DTI to detect white matter damage in the CC of mTBI patients.

In order to clarify the feature of attention disorders in schizophrenia, two tasks (X and AX) of the Continuous Performance Test (CPT) were given to 36 schizophrenic patients and 25 healthy controls. The schizophrenic patients performed considerably less well than normal controls. Performances were expressed in indices such as omission and commission errors, reaction time and discriminability. Among errors, omission in both the X and AX tasks was found to be an index that varied in reaction time, indicating difficulty in sustaining attention. Omission was found to act as a state-dependent index of schizophrenia in relation to inattentiveness in clinical settings and emotional disturbance in interpersonal situations. Commission, in contrast, differed between the two tasks, acting as an index of disinhibition of reaction in the X task, and of disturbance of the capacity and allocation of attention in the AX task. Commission was also thought to be an index related to thought disorder during episodes of acute schizophrenia, that is, it reflects an essential pathology in schizophrenia.

Latent structures of schizophrenic phenomenology were examined over the course of the illness in 100 newly-admitted patients. We compared the results of a confirmatory factor analysis (CFA) on ten competing models that had between zero and five dimensions using data assessed by the Positive and Negative Syndrome Scale (PANSS) at both the acute and chronic phases of the disease. The present findings did not support the two-dimensional construct of positive and negative symptoms in either the acute or the chronic phase of the illness. In the acute phase, a three- (positive, negative, and relational dimensions), four- (positive, negative, disorganization, and relational dimensions), and five-dimensional model (positive, negative, disorganization, excitement, and relational dimensions) fit the data relatively well. In contrast, in the chronic stable phase, only the five-dimensional model adequately fits the data. The present findings suggest that further investigation of the validity of the five-dimensional model over the course of the illness is necessary.

Prospective and longitudinal assessment of depressive, positive, and negative symptoms were performed on 86 newly admitted schizophrenic patients. The improvement of depressive symptoms was significantly correlated with the improvement in positive symptoms, but did not correlate with the improvement in negative symptoms. However, depressive symptoms were heterogeneous. Principal components analysis was used to subdivide depressive symptoms into five factors. The improvement of the depression-anxiety factor was significantly associated with improvement of positive symptoms. On the other hand, improvement of negative symptoms was significantly related to that of the reduced activity factor. The change in hypochondriasis had a significant positive correlation with the change in positive symptoms and had a significant negative correlation with the change in negative symptoms. Changes in the other factors of depressive symptoms did not appear to be associated with changes in positive or negative symptoms. The present findings suggest that the various depressive symptoms associated with acute schizophrenia may have different pathophysiological origins.

Structural and functional neuroimaging findings suggest that disturbance of the cortico-striato-thalamo-cortical (CSTC) circuits may underlie obsessive-compulsive disorder (OCD). However, some studies with (1)H-magnetic resonance spectroscopy ((1)H-MRS) reported altered level of N-acetylaspartate (NAA), they yielded inconsistency in direction and location of abnormality within CSTC circuits. We conducted a comprehensive literature search and a meta-analysis of (1)H-MRS studies in OCD. Seventeen met the inclusion criteria for a meta-analysis. Data were separated by frontal cortex region: medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex, orbitofrontal cortex, basal ganglia and thalamus. The mean and s.d. of the NAA measure were calculated for each region. A random effects model integrating 16 separate datasets with 225 OCD patients and 233 healthy comparison subjects demonstrated that OCD patients exhibit decreased NAA levels in the frontal cortex (P=0.025), but no significant changes in the basal ganglia (P=0.770) or thalamus (P=0.466). Sensitivity analysis in an anatomically specified subgroup consisting of datasets examining the mPFC demonstrated marginally significant reduction of NAA (P=0.061). Meta-regression revealed that NAA reduction in the mPFC was positively correlated with symptom severity measured by Yale-Brown Obsessive Compulsive Scale (P=0.011). The specific reduction of NAA in the mPFC and significant relationship between neurochemical alteration in the mPFC and symptom severity indicate that the mPFC is one of the brain regions that directly related to abnormal behavior in the pathophysiology of OCD. The current meta-analysis indicates that cortices and sub-cortices contribute in different ways to the etiology of OCD.

The authors surveyed the prevalence of depression and dementia in the elderly in Ohira town in Japan from 1989 to 1990. The total population of this town was 26,712, with 2,778 people aged 65 and above, constituting 10.4% of the total population. The prevalence of dementia (n = 128) was 6.1% and that of major depression (n = 9) was 0.4%, according to the DSM-III-R criteria. The prevalence of a depressive state which did not fulfill the criteria for major depression (n = 55) was 2.4%. The patients with multi-infarct dementia (n = 49) suffered from depression (42.8%) more frequently than those with dementia of the Alzheimer type (11.1%). The rate of depression coexisting with dementia increased with aging, while the rate of depression without dementia did not change in all the age groups.

A 58-year-old male consulted our hospital because of penile swelling and pain with bilateral inguinal lymphadenopathy. Pathological examination of the penile tumor and right superficial inguinal lymph node biopsy demonstrated moderately differentiated squamous cell carcinoma with lymph node metastasis. We diagnosed the tumor inoperable radically and adjuvant chemotherapy with methotrexate, cisplatin and bleomycin was administered, followed by partial penectomy and left superficial lymphadenectomy. The surgical specimens showed few viable tumor cells. This combination chemotherapy is suggested to be effective for the treatment of advanced penile cancer.

Electroconvulsive therapy (ECT) recovers the brain function through generalized convulsion induced by electrical stimulation of the brain. While the primary targets of ECT are psychiatric disorders such as depression, schizophrenia, and schizoaffective disorder, it has been well documented that ECT has therapeutic effects on muscular rigidity of Parkinson's disease and neuroleptics-induced malignant syndrome. Recently we demonstrated that ECT reduces intractable pain and allodynia associated with deafferentation pain disorders by recovering the function of the thalamic nucleus. ECT, if applied on appropriate clinical assessments, may contribute to the therapeutics of neuropsychiatric disorders.

The difference in symptomatology between the acute and post-acute phase of schizophrenia was examined in the present study using prospective and longitudinal assessment of 86 newly admitted schizophrenic patients. In the acute phase of illness, four symptom components emerged (negative symptoms, excited, delusional/hallucinatory, and thought disorder) and three components were evident (negative symptoms, mixed symptoms, and thought disorder) in the post-acute phase. The negative component in the post-acute phase had the same composition as that in the acute phase. The composition of thought disorder barely persisted over the phase of illness. These findings suggest that the negative symptom component is stable while the difference in the phase of illness has some effects on the symptom structure of schizophrenia.

Poliovirus receptor (PVR) is a cell surface glycoprotein that belongs to the immunoglobulin superfamily. Although MPH was initially reported as the mouse homolog of human PVR, recent data strongly suggest that MPH is the mouse homolog of human PRR2, a PVR-related gene 2 product, and not that of human PVR. Thus MPH is renamed mPRR2 in this study. Physiological functions of the PVR-related gene products have not been elucidated, although PVR has been well characterized as the poliovirus receptor. In this study, a possible function of mPRR2 (MPH), which is not a functional receptor for poliovirus, was investigated. Mouse L cells expressing mPRR2 were prepared. Those mouse cells showed a higher activity of cell aggregation than the parental mouse L cells. Enhancement of cell aggregation was also observed for insect Sf9 cells infected with recombinant baculovirus carrying mPRR2 cDNA. On the other hand, L cells expressing human PVR or monkey PVR (AGM alpha1 or AGM alpha2) did not show increased cell aggregation. The cell aggregation activity of L cells expressing mPRR2 was inhibited by the addition of anti-mPRR2 monoclonal antibodies or a soluble mPRR2 molecule produced by the baculovirus expression system. An immunofluorescence study revealed that mPRR2 protein was localized to the cell-cell contact sites between cells expressing mPRR2. A similar localization of mPRR2 was observed for intrinsic mPRR2 molecules of the mouse neuroblastoma cell line NS20Y. The contact site-specific localization of mPRR2 was not observed on the border between mPRR2-expressing and nonexpressing HeLa cells. Furthermore, mPRR2 proteins directly bound to each other in vitro. mPRR2 was detected on various types of cultured cells of mouse origin and in various mouse tissues. These results suggest that mPRR2 is an intercellular adhesion molecule with a homophilic binding manner.

An autopsy case of blue rubber bleb naevus syndrome (BRB-NS) is reported. There was the usual occurrence of cavernous haemangioma in the skin and intestine and cardiac involvement by a haemangiomatous lesion might have directly led to the patient's death. By light and electron microscopy, all the haemangiomatous lesions examined were cavernous with the exception of the cardiac tumour which was a mixed-vessel (capillary and cavernous) type of a haemangioma. These findings indicate that any vascular tumour-like lesions may occur in BRBNS. The principal combination of haemangiomas in the skin and intestine in BRBNS regardless of their type is the typical feature of this syndrome.